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Neonatal Abstinence Syndrome

This information sheet aims to answer some commonly asked questions about neonatal abstinence syndrome (NAS).

Important: This is general information only. It is not intended as advice for your individual circumstances. Ask your health care provider for more information. 

What is Neonatal Abstinence Syndrome (NAS)

During pregnancy, your baby can become addicted to or dependent on substances (drugs) you take before he or she is born. 

After birth, when your baby is no longer getting that drug, they may show signs of withdrawal. This is called Neonatal Abstinence Syndrome (or NAS). 

Signs of NAS usually develop within a few hours to a few days of birth. 

How do you know your baby has NAS?

The signs of NAS vary depending on the drugs you have been using. Common signs of withdrawal in a baby are: 

  • excessive crying, tremors and jitteriness 
  • poor feeding and vomiting 
  • unable to settle and sleep properly 
  • excoriated (sore and red) skin especially in the nappy area but may also be on the face and other parts of the body 
  • loose bowel motions 
  • fever.

Can you breastfeed if your baby has NAS?

Breastfeeding is the natural and best way to feed your baby. It is better to not use drugs than to not breastfeed. 

Although most of the time it is safe to breastfeed, some drugs pass into or build up in breast milk and can pass to your baby during breastfeeding. Even low levels may cause your baby to feed poorly, be drowsy, have poor weight gain and upset their sleep patterns. 

There may also be effects later on such as behavioural and learning difficulties. Your healthcare provider will discuss the drug(s) you use and if and when it is safe to give your baby breast milk. 

Can your baby stay with your after birth?

If everything else is ok, your baby can usually remain with you after birth. The midwife/nurse looking after you both will check your baby regularly using a scoring chart (Finnegan score). Your baby is given a score based on the signs of NAS they show. If the score becomes high, it may be necessary to admit your baby to a special care nursery.

Ask your health care provider about your baby’s scores and how you can be involved in the assessments. 

What are the treatments for NAS?

Supportive care is very important. This involves you and your partner cuddling, swaddling (wrapping up), rocking and generally comforting your baby. If you are with your baby as much as possible you will be able to respond to their needs when they are unsettled. 

Often these babies are very hungry and want to feed a lot. If you are breastfeeding, you will be able to breastfeed whenever your baby wants to. 

If you are formula feeding you will be able to give your baby regular small feeds. Your connection with your baby is very important for their long term emotional and mental health. 

Medication is sometimes needed to help manage your baby’s withdrawal – morphine and/or phenobarbital (phenobarbitone) are prescribed. 

The amount and frequency of medication depends on the signs of withdrawal your baby is showing. The medication is gradually reduced as your baby‘s signs of withdrawal lessen. 

How long does your baby have to stay in hospital?

The number of days your baby will need to stay in hospital depends on the type of drug(s) causing the NAS. For some drugs, it is 3–5 days and for others it can be for a week or longer. 

Staying in hospital means your baby’s health can be closely monitored and medication can be given if needed. Your health care provider will give you more information about this. 

Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: PI-CLN-430125
Last modified 17/4/2020.
Consumers were consulted in the development of this patient information.
Last consumer engagement date: 19/3/2020
For further translated health information, you can visit healthtranslations.vic.gov.au/ supported by the Victorian Department of Health and Human Services that offers a range of patient information in multiple languages.
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